TY - JOUR
T1 - Agreement in electrocardiogram interpretation in patients with septic shock
AU - Mehta, Sangeeta
AU - Granton, John
AU - Lapinsky, Stephen
AU - Newton, Gary
AU - Bandayrel, Kristofer
AU - Little, Anjuli
AU - Siau, Chuin
AU - Cook, Deborah
AU - Ayers, Dieter
AU - Singer, Joel
AU - Lee, Terry
AU - Walley, Keith
AU - Storms, Michelle
AU - Cooper, David
AU - Holmes, Cheryl
AU - Hebert, Paul
AU - Gordon, Anthony C
AU - Presneill, Jeffrey J
AU - Russell, James
PY - 2011
Y1 - 2011
N2 - Objective: The reliability of electrocardiogram interpretation to
diagnose myocardial ischemia in critically ill patients is unclear.
In adults with septic shock, we assessed intra- and inter-rater
agreement of electrocardiogram interpretation, and the effect of
knowledge of troponin values on these interpretations.
Design: Prospective substudy of a randomized trial of vasopressin
vs. norepinephrine in septic shock.
Setting: Nine Canadian intensive care units.
Patients: Adults with septic shock requiring at least 5 g/min
of norepinephrine for 6 hrs.
Interventions: Twelve-lead electrocardiograms were recorded
before study drug, and 6 hrs, 2 days, and 4 days after study drug
initiation.
Measurements: Two physician readers, blinded to patient
data and group, independently interpreted electrocardiograms
on three occasions (first two readings were blinded to patient
data; third reading was unblinded to troponin). To calibrate and
refine definitions, both readers initially reviewed 25 trial electrocardiograms
representing normal to abnormal. Cohena??s
Kappa and the statistic were used to analyze intra- and
inter-rater agreement.
Results: One hundred twenty-one patients (62.2 16.5 yrs, Acute
Physiology and Chronic Health Evaluation II 28.6 7.7) had 373
electrocardiograms. Blinded to troponin, readers 1 and 2 interpreted
46.4 and 30.0 of electrocardiograms as normal, and 15.3 and
12.3 as ischemic, respectively. Intrarater agreement was moderate
for overall ischemia ( 0.54 and 0.58), moderate/good for a??normala??
( 0.69 and 0.55), fair to good for specific signs of ischemia (ST
elevation, T inversion, and Q waves, reader 1 0.40 to 0.69; reader
2 0.56 to 0.70); and good/very good for atrial arrhythmias ( 0.84
and 0.79) and bundle branch block ( 0.88 and 0.79). Inter-rater
agreement was fair for ischemia ( 0.29), moderate for ST elevation
( 0.48), T inversion ( 0.52), and Q waves ( 0.44), good for bundle
branch block ( 0.78), and very good for atrial arrhythmias ( 0.83).
Inter-rater agreement for ischemia improved from fair to moderate (
0.52, p .028) when unblinded to troponin.
Conclusions: In patients with septic shock, inter-rater agreement
of electrocardiogram interpretation for myocardial ischemia
was fair, and improved with troponin
AB - Objective: The reliability of electrocardiogram interpretation to
diagnose myocardial ischemia in critically ill patients is unclear.
In adults with septic shock, we assessed intra- and inter-rater
agreement of electrocardiogram interpretation, and the effect of
knowledge of troponin values on these interpretations.
Design: Prospective substudy of a randomized trial of vasopressin
vs. norepinephrine in septic shock.
Setting: Nine Canadian intensive care units.
Patients: Adults with septic shock requiring at least 5 g/min
of norepinephrine for 6 hrs.
Interventions: Twelve-lead electrocardiograms were recorded
before study drug, and 6 hrs, 2 days, and 4 days after study drug
initiation.
Measurements: Two physician readers, blinded to patient
data and group, independently interpreted electrocardiograms
on three occasions (first two readings were blinded to patient
data; third reading was unblinded to troponin). To calibrate and
refine definitions, both readers initially reviewed 25 trial electrocardiograms
representing normal to abnormal. Cohena??s
Kappa and the statistic were used to analyze intra- and
inter-rater agreement.
Results: One hundred twenty-one patients (62.2 16.5 yrs, Acute
Physiology and Chronic Health Evaluation II 28.6 7.7) had 373
electrocardiograms. Blinded to troponin, readers 1 and 2 interpreted
46.4 and 30.0 of electrocardiograms as normal, and 15.3 and
12.3 as ischemic, respectively. Intrarater agreement was moderate
for overall ischemia ( 0.54 and 0.58), moderate/good for a??normala??
( 0.69 and 0.55), fair to good for specific signs of ischemia (ST
elevation, T inversion, and Q waves, reader 1 0.40 to 0.69; reader
2 0.56 to 0.70); and good/very good for atrial arrhythmias ( 0.84
and 0.79) and bundle branch block ( 0.88 and 0.79). Inter-rater
agreement was fair for ischemia ( 0.29), moderate for ST elevation
( 0.48), T inversion ( 0.52), and Q waves ( 0.44), good for bundle
branch block ( 0.78), and very good for atrial arrhythmias ( 0.83).
Inter-rater agreement for ischemia improved from fair to moderate (
0.52, p .028) when unblinded to troponin.
Conclusions: In patients with septic shock, inter-rater agreement
of electrocardiogram interpretation for myocardial ischemia
was fair, and improved with troponin
U2 - 10.1097/CCM.0b013e318222720e
DO - 10.1097/CCM.0b013e318222720e
M3 - Article
SN - 0090-3493
VL - 39
SP - 2080
EP - 2086
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 9
ER -